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NEW DELHI, INDIA, June 2, 2001: A range of tobacco-based products has made India the "number one oral-cancer country," according to the Indian Society of Tobacco and Health. They also contributed to around 4.5 million cardio-vascular-disease cases and 3.9 million chronic obstructive pulmonary-disease cases. Of the range of cheap tobacco-based products on sale across India "gutkha" is probably the fastest growing. Gutkha, which is put in the mouth, is a sweetened mix of tobacco, betel and catechu with lime, menthol, sandal oil and some amount of spice and unspecified flavoring. It is consumed mostly by the middle and lower-middle class, including women and children who circumvent taboos against smoking by chewing the product. While gutkha has been around for a long time, it has been repackaged to appeal to children over the last three to four years. Users as young as 12 in India have been diagnosed with precancerous lesions. A National Institute of Occupational Health report on chemical analysis of paan masala -- which is a close relative of gutkha showed the presence of harmful substances such as polycyclic aromatic hydrocarbons and nitrosamines, toxic metals such as lead, cadmium and nickel and residues of pesticides. Last year, the Maharashtra state government was forced to ban its sale within 100 meters of schools, colleges and government offices in Bombay, after researchers noted a dramatic rise in consumption by children.